Pre-authorization requirements differ between plans, so please refer to your Policy Terms and Conditions for the official list of services requiring pre-authorization.
Please call us if you have any doubts on coverage.
ConciergeCare U.S. +1-855-773-7810
ConciergeCare International: +1-786-453-4008 (collect)
Email: conciergecare@payerfusion.com
Benefits and services requiring pre-authorization may be and are not limited to the following:
• DME Supplies
• Medications that are over $250
• Specialty Drugs
• Breast Reconstructive Surgery
• Dental-related Services
• Enteral nutrition
• High-cost Prescription Drugs
• High-dose chemotherapy and/or radiation therapy with Bone Marrow Transplant and/or peripheral stem cell support
• Home Health Care/IV home therapy
• Hospice care
• Human organ Transplants
• Skilled Nursing
• Obesity and weight loss services
• Orthognathic surgery
• Reconstructive surgery
• Prescription Drugs, as denoted with a special symbol in the Medication Guide
• Advanced diagnostic imaging Services, such as CT scans, MRIs, MRA and nuclear imaging
• Behavioral Health Services
• Medically Necessary contact lenses as indicated in the Eye Care and 17. Services rendered in connection with Approved Clinical Trials
• Allergy testing & treatment
• Behavioral health
• Outpatient physical therapy
• Outpatient chiropractic & spinal manipulation
• Habilitative services
• Rehabilitative services
• Advanced diagnostic and imaging services: MRI, CT, PET, MRA, angiography, nuclear imaging, biopsy, CTA, CT coronary angioplasty, diagnostic colonoscopy/endoscopy.
• Oncology treatment, drugs & reconstructive surgery
• Outpatient ambulatory surgical facility & surgical care
This material is for informational purposes only and is subject to change. Please refer to your Policy Terms and Conditions for a complete description of the benefits, conditions, limitations and exclusions of coverage. Products and services may not be available in all jurisdictions and are expressly excluded where prohibited by applicable law.